A.

Stroke Like
1. Dispatch information:
a. Time: 9.00am
b. 58 year old gentleman complaint stroke live symptom
c. Location: Ivory Condominium Jalan ABC, Penang
2. Scene Assessment:
a. Family member guide you to living room. Patient is lying semi-fowlers position on
sofa presented with confuse, facial droop, saliva drooling
3. Initial Assessment:
a. LOC: Response to Verbal Stimuli
b. A: Airway clear, as patient able product sound upon painful stimuli
c. B: Normal Breathing rate and effort, 20/min, SPO2: 90%
d. C: Radial Pulse: 98/min, regular, BP: 138/60 mmHg, CRT=2s, Skin: Cool & clammy,
sweating
e. D: decreases power on 4 limbs but equal power, Babinski test -ve, BGL: 1.5
mmol/L, T: 37.0
4. Focused History and Physical Exam:
a. Present History:
History obtained from Pts daughter. She complaint that patient was normal
previously. Today morning suddenly become unresponsiveness and presented stroke
like symptom.
b. Past Medical History
i. S: Facial Drop, Slurred Speech, Saliva drooling, unable to move 4 limbs,
Fever, Cough, Poor Oral Intake, Decrease of appetite
ii. A: Unknown allergy
iii. M: Metformine, gliclazide, atenolol, aspirin, frusemide, insulin injection- 16
unit night
iv. P: HPT, DM, IHD (PCI @ 2007), CCF
v. L: Yesterday Dinner- biscuit (Poor Oral Intake)
c. Physical Exam:
i. Head: No Trauma
ii. Neck: no trauma
iii. Check: No scar, not trauma, auscultation bilateral lower lobe fine crackle air
entry equal,
iv. Heart Tone: DRNM
v. PA: SNT
vi. Neuro: 4 limbs poor power movement but equal both side, Babinski test
response to sensation, CPHSS- -ve
vii. Bilateral Pedal Oedema
d. Vital Signs:
i. RR: 20/min, SPo2: 90% (RA),
ii. Radial Pulse: 98/min, regular, BP: 138/60 mmHg, CRT=2s, Skin: Cool &
clammy, sweating
iii. BGL: 1.5 mmol/L
iv. LOC: Confuse, response to verbal stimuli
5. Management:
ABC, ? IV dextrose 10% - 20ml titrate with Mental Status, monitoring the patient vital signs
6. Ongoing Assessment:
Post- dextrose:
i. RR: 20/min, SPo2: 97% (NC-2lpm),
ii. Radial Pulse: 98/min, regular, BP: 136/68 mmHg, CRT=2s, Skin: Cool &
clammy, sweating
iii. BGL: 11.8 mmol/L (20ml)

iv. LOC: Alert conscious oriented

B. Chest Pain
1. Dispatch information:
b. Time: 9.00am
c. 32 year old gentleman complaint shortness of
d. Location: Taman Bagan Luar Jalan Bagan Dalam, Penang
2. Scene Assessment:
e. Patient standing in front of his house waiting for ambulance. Patient alert conscious
oriented tachypnea.
3. Initial Assessment:
f. LOC: Alert conscious and oriented
g. A: Airway clear, as patient able to communicate with you
h. B: Increase Breathing rate, normal effort, 28/min, SPO2: 100%
i. C: Radial Pulse: 108/min, regular, BP: 138/72 mmHg, CRT<2s, Skin: Warm & dry
j. D: Able to move 4 limbs, neurological intact, BGL: HI (>30.0 mmol/L), T: 37.2
4. Focused History and Physical Exam:
k. Present History:
History obtained from Pt. Patient complaint that he was experienced mild shortness of
breath in the past few days today morning when he wake up from sleep around 8am
getting worst and with mild chest discomfort. He get worried and call ambulance. At
the same time he complaint that, he has a fever and cough 3 weeks ago, subsequently
associated poor oral intake, nausea & vomiting, unable to tolerate orally
l. Past Medical History
i. S: shortness of breath, chest discomfort, vomiting,
ii. A: Unknown allergy
iii. M: metoprolol, insulin injection- 22,16,16, 20
iv. P: HPT, DM,
v. L: Yesterday dinner
m. Physical Exam:
i. Head: No Trauma
ii. Neck: no trauma
iii. Check: No scar, not trauma, auscultation lung clear air entry equal,
iv. Heart Tone: DRNM
v. PA: SNT
vi. Neuro: 4 limbs poor power movement but equal both side, Babinski test
response to sensation, CPHSS- -ve
vii. No Pedal Oedema
viii. Pink, dehydration
n. Vital Signs:
i. RR: 28/min, SPo2: 100% (RA),
ii. Radial Pulse: 108/min, regular, BP: 138/72 mmHg, CRT<2s, Skin: warm &
dry
iii. BGL: HI mmol/L
iv. Serum Ketone: 2.5 mmol/L (< 0.6 mmol/L)
v. LOC: alert, conscious, oriented
5. Management:
ABC, ? IV Normal Saline 0.9 % - 20ml/kg, monitoring the patient vital signs
6. Ongoing Assessment:
Post- saline:
vi. RR: 24/min, SPo2: 100% (NRM- 10 lpm),
vii. Radial Pulse: 106/min, regular, BP: 136/68 mmHg, CRT<2s, Skin: warm 7
dry
viii. BGL: HI

ix. LOC: Alert conscious oriented

c. Bodyweakness
1. Dispatch information:
a. Time: 9.00am
b. 64 year old lady complaint body weakness
c. Location: Jalan Bakar sampah, Penang
2. Scene Assessment:
Pt son guide you into patient bed room. Upon enter the room, you found that patient
lying supine position on bed, eye opening. As you approach the patient, patient is
alert conscious and oriented. He complaint to you that he feel week, unable to get up
from bed.
3. Initial Assessment:
a. LOC: Alert conscious and oriented
b. A: Airway clear, as patient able to communicate with you
c. B: Normal Breathing rate, normal effort, 16/min, SPO2: 98%
d. C: Radial Pulse: 88/min, regular, BP: 126/70 mmHg, CRT<2s, Skin: Warm & dry
e. D: Able to move 4 limbs, neurological intact, BGL: 2.1 mmol/L, T: 37.2
4. Focused History and Physical Exam:
a. Present History:
History obtained from Pt. Patient complaint that he has fever in the past 4 days,
associated with cough. Went to clinic some medication was given. 2 days ago, loss of
appetite, and poor oral intake. This few day he just have one to 2 slide of bread, skip
yesterday dinner.
b. Past Medical History
i. S: Fever, Cough, generalized body weakness, loss of appetite
ii. A: Unknown allergy
iii. M: metoprolol,amlodipine , metformin, gliclazide
iv. P: HPT, DM,
v. L: Yesterday lunch
c. Physical Exam:
i. Head: No Trauma
ii. Neck: no trauma
iii. Check: No scar, not trauma, auscultation lung clear air entry equal,
iv. Heart Tone: DRNM
v. PA: SNT
vi. Neuro: able to move 4 limbs neurological intact
vii. No Pedal Oedema
d. Vital Signs:
i. RR: 16/min, SPo2: 98% (RA),
ii. Radial Pulse: 88/min, regular, BP: 126/70 mmHg, CRT<2s, Skin: moist &
cold
iii. BGL: 2.1 mmol/L
iv. LOC: alert, conscious, oriented
5. Management:
ABC, oral glucose, monitoring the patient vital signs
6. Ongoing Assessment:
Post- oral glucose:
i. RR: 14/min, SPo2: 98% (RA),
ii. Radial Pulse: 78/min, regular, BP: 122/68 mmHg, CRT<2s, Skin: moist, cold
iii. BGL: 11.2 mmol/L
iv. LOC: alert, conscious, oriented